Provider Demographics
NPI:1841569191
Name:PORFILIO, BRUCE ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:PORFILIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 S CANON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4554
Mailing Address - Country:US
Mailing Address - Phone:424-777-0890
Mailing Address - Fax:
Practice Address - Street 1:434 S CANON DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4554
Practice Address - Country:US
Practice Address - Phone:424-777-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist